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Please Explain Why We Reduce Joint (Knee) Swelling

post #1 of 11
Thread Starter 

To the amazement of my OS and PT, both my knee injuries had prolonged swelling.  Each injury had me fighting swelling, even to the point of getting my knees drained several times each.  The OS told me that typically his patients would get the swelling down, have the surgery and the swelling wouldn't come back.  With me, it comes back and I end up dealing with it for months on end post surgery. 

 

My left knee still swells now and agian and the surgery was in July of '08.  I'm currently over 2 months post ACL reconstruction of my right knee and the only thing preventing me from walking perfectly is the swelling.  With the left knee I went from July to November before the swelling was gone enough for me to get my leg completely strainght.  This time around it isn't as bad but it is still there.  Just enough to keep me from extending my leg while walking; I'm about 2-3 degrees shy.

 

I've always thought of swelling, at least in the joint, as natures splint.  Most times our bodies do something to aid in healing.  The swelling seems to be slowing me down.  Maybe I'm interpreting it wrong but why else would the swelling still be there?  I try to not take pain killer because masking pain can cause you to make something worse. 

 

By fighting the swelling, am I masking something?  The OS said the surgery was hugely sucessful and PT says I'm doing great!

 

Any ideas or thoughts on the matter?

 

Thanks,

Ken

post #2 of 11

May or may not be related, but I learned when I damaged some bones in my hand that prolonged inactivity promotes swelling and activity, up to a point, reduces swelling.  The trouble is finding that "point".

post #3 of 11
Thread Starter 

If that is the case I must be hovering on each side of "the point".  I do notice that when I get up from my desk after sitting at it for a while, it takes a few steps to loosen up.  Same thing happened last time. tapers off.  I do walk a bit at work; very large building and I always seem to be on the opposite side of the building from the next meeting.  But a big part of my job involves sitting.

post #4 of 11

I agree that swelling can be nature's splint, but moderate, controlled activity may be the best way to rehab.

 

check this out http://www.exrx.net/ExInfo/FirstAid.html

 

Ice

  • Hastens healing time by reducing swelling around injury
    • Sudden cold contracts blood vessels
    • Helps stop internal bleeding from injured capillaries and blood vessels

Compression

  • Hastens healing time by reducing swelling around injury
    • Decreases seeping of fluid into injured area from adjacent tissue

 

My take on the above is that it is probably good to get the blood flowing through an injured area with Icing helping to move some of the "old" blood out and make way for new blood in.

 

While limiting range of motion might be a good thing at times, if you are limited for too long, it might be harder to get it back.

 

 

post #5 of 11



 

Quote:
Originally Posted by MEfree30 View Post

 controlled activity may be the best way to rehab.

 

 

+1.  You need to find the middle ground.  Swelling post sx is not at all uncommon.  Most folks can expect some for 6-12 mo.  There are always outliers & such.  

 

 One of the most important reasons to decrease edema is to restore the normal proprioception & response to the joint.  This avoids secondary dysfunction.  Often the compensations are worse in the long run.  Adaptive shortening & scar tissue can limit motion + weakness (both sides) from a decline in activity can really challenge a body 

post #6 of 11
Thread Starter 
Quote:
Originally Posted by MEfree30 View Post

I agree that swelling can be nature's splint, but moderate, controlled activity may be the best way to rehab.

 

check this out http://www.exrx.net/ExInfo/FirstAid.html

 

Ice

  • Hastens healing time by reducing swelling around injury
    • Sudden cold contracts blood vessels
    • Helps stop internal bleeding from injured capillaries and blood vessels

Compression

  • Hastens healing time by reducing swelling around injury
    • Decreases seeping of fluid into injured area from adjacent tissue

 

My take on the above is that it is probably good to get the blood flowing through an injured area with Icing helping to move some of the "old" blood out and make way for new blood in.

 

While limiting range of motion might be a good thing at times, if you are limited for too long, it might be harder to get it back.

 

 


MEfree30,

I agree with everything you stated and the link.  Especially the part about getting it back.  Last time and this time, I limped so long that it became natural and I had to concentrate to not limp. 

 

If anything, I might be doing too little.  The OS warned me and my PT that I needed to make sure to be dialed down this time.  The concern was that I tend to be aggressive with my PT and since I got "used parts" (cadaver), the concern was that I would damage it since it continues to weaken for the first 12 weeks.  I took that to heart and work primarily on ROM and I don't do anything until PT tells me to start.  I'm on the verge of being a "slacker".

 

I do wear one of those tube things doubled up over my knee.  If I don't, it's much worse.

 

Ken

 

 

post #7 of 11
Thread Starter 
Quote:
Originally Posted by iriponsnow View Post


+1.  You need to find the middle ground.  Swelling post sx is not at all uncommon.  Most folks can expect some for 6-12 mo.  There are always outliers & such.  

 

 One of the most important reasons to decrease edema is to restore the normal proprioception & response to the joint.  This avoids secondary dysfunction.  Often the compensations are worse in the long run.  Adaptive shortening & scar tissue can limit motion + weakness (both sides) from a decline in activity can really challenge a body 


iriponsnow,

 

I think the OS wasn't concerned about there still being swelling but how much there is.

 

Re: Secondary dysfuntion:

 

My back is a little messed up (slight scoliosis) and when my gait isn't right, it acts up, travels up my back, into my neck and Ken gets a migraine.  I do stretch my back everyday and go to a chiropractor regularly for my "tune up".

 

Thanks,

Ken

 

 

 

 

 

 

post #8 of 11
post #9 of 11
Thread Starter 


Between work and life it took me a while to get to this.  Does anyone know of any clinical studies that compare techniques?  If you search the internet, you can find sites just as convincing that the products they're selling are the best way.  I'm always skeptical of sites that agree with me confused.gif.

 

I see the OS tomorrow and though the swelling is within reason (for me), I think I'm going to get an earful because I've been slacking too long (working way too many hours and getting home exhausted - I know hissyfit.gif,hissyfit.gif,hissyfit.gif).  I feel I should/could be stronger by now and I've put on 10 #'s so I'm sure he'll call me on it.

 

The good news is my PT got me a Flex IT.  It's a TEMS that does interferential therapy.  I've been using it on my back and shoulder more than my knee but it works great on the knee.  I just received special pads to use for the knee so that should be more helpful.

 

And more whining...

 

I think my biggest problem (other than work) is that I let myself get caught in a tailspin; don't have full extension in the knee, so I walk funny, which causes my back to hurt, so I don't want to PT, which prolongs my knee swelling/limited ROM, which prolongs my back pain. and so on...

 

I'll start anew tomorrow.  Today's father's day which means I have to enjoy the day (the way my wife wants me too Rules.gif) so I'll crack down tomorrow.

 

Thanks for all the info and links,

 

Ken

post #10 of 11
Quote:
Originally Posted by L&AirC View Post

If that is the case I must be hovering on each side of "the point".  I do notice that when I get up from my desk after sitting at it for a while, it takes a few steps to loosen up.  Same thing happened last time. tapers off.  I do walk a bit at work; very large building and I always seem to be on the opposite side of the building from the next meeting.  But a big part of my job involves sitting.


Get up, stand up! I sit for hours (and hours and hours) at work too, and it's terrifically destructive, to say nothing of being completely unhelpful for injuries and damaging for the back. It's also bad for circulation, and that leg just sits there gathering fluid. Get up and walk around your office for a few minutes every 45-60 minutes; gently stretch your arms, upper back, quads and hamstrings before sitting down. When you sit for a while, lean back if you have a backrest (I know, it's counter-intuitive, but easier on the lower back), prop your leg up on a desk drawer for a while, etc. Maybe try sitting on an exercise ball for part of the day (don't try to prop your legs up or lean back on that, though). It's good for the brain, too; I get more done if I remember just move around a bit. I realized that when I noticed that I feel best when I'm getting up every 15 minutes to get drafts from the printer. Now I read my drafts while standing at the counter beside our printer so I get even more time out of my chair.

I have trouble remembering to do this unless I set a timer on my cell phone. Try it for a week and see if it helps. It
post #11 of 11
Thread Starter 

litterbug,

 

I think the alarm is the way to go.  Once I'm on the computer, unless "Outlook" tells me to go somewhere, or someone stops by, I'll stay at it for hours on end.  I do go for walks now and again but too infrequent and it is usually for a cup a coffee so I can stay at my computer longer.

 

Thanks,
Ken

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